Integration of five health behaviour models: common strengths and unique contributions to understanding condom use

The purpose of this research was to select from the health belief model (HBM), theories of reasoned action (TRA) and planned behaviour (TPB), information-motivation-behavioural skills model (IMB) and social cognitive theory (SCT) the strongest longitudinal predictors of women's condom use and to combine these constructs into a single integrated model of condom use. The integrated model was evaluated for prediction of condom use among young women who had steady versus casual partners. At Time 1, all constructs of the five models and condom use were assessed in an initial and a replication sample (n?=?193, n?=?161). Condom use reassessed 8 weeks later (Time 2) served as the main outcome. Information from IMB, perceived susceptibility, benefits, and barriers from HBM, self-efficacy and self-evaluative expectancies from SCT, and partner norm and attitudes from TPB served as indirect or direct predictors of condom use. All paths replicated across samples. Direct predictors of behaviour varied with relationship status: self-efficacy significantly predicted condom use for women with casual partners, while attitude and partner norm predicted for those with steady partners. Integrated psychosocial models, rich in constructs and relationships drawn from multiple theories of behaviour, may provide a more complete characterisation of health protective behaviour.     

HIV-protection through condom use: Testing the theory of planned behaviour in a community sample of heterosexual men in a high-income country

Given the increasing importance of heterosexual HIV-transmission in Europe and Switzerland, the present study tested the theory of planned behaviour (TPB) in a prospective study on the HIV-protection behaviour in a community sample of heterosexual men. The study focused on condom use in sexual encounters with new partners. Participants were 982 Swiss men between the ages of 25 and 65 who were surveyed using standardised questionnaires in two computer-assisted telephone interviews that took place in autumn 2002 and spring 2003. The TPB was able to predict condom use in sexual encounters with new and casual partners. In accordance with the theory, condom use was predicted by intention. Perceived behavioural control and attitude were significant predictors of intention, whereas subjective norm was not. Thus, in line with other studies, the present study highlighted the somewhat limited explanatory power of the theory. Further theoretical and empirical work is needed to develop extensions to the theory.     

Application of an Integrated Behavioral Model to Predict Condom Use: A Prospective Study Among High HIV Risk Groups1

An integrated theoretical model using constructs from multiple behavioral models was applied to understand and predict condom use among a sample of injecting drug users, commercial sex workers, men who have sex with men, and multipartnered heterosexuals. Elicitation interviews were conducted to develop a questionnaire to measure model constructs that may be predictive of condom use for sex with vaginal, anal, and oral regular and casual partners. A prospective survey design was used, with 993 participants interviewed at Time 1, and 686 returning for Time 2 interviews 3 months later. Regression analyses were conducted using Time 1 measures to predict intention and Time 2 behavior. Strong support was found for a model that includes attitude, social norm, and facilitators/constraints as predictors of behavior, with multiple correlations in the 0.20 to 0.40 range. Findings also indicate perceived control and facilitators/constraints are distinct constructs and both, along with attitude and social norm, contribute to explaining behavioral intention. Implications for intervention development are discussed.     

Bringing up condom use and using condoms with new sexual partners: Intentional or habitual?

Abstract

A prospective study of 94 Dutch adults who have casual sexual partners examined whether two important aspects of safe sex, namely bringing up condom use (BCU) and actual condom use (ACU) are intentional or habitual. For each of these aspects, a model based on the Theory of Planned Behaviour (TPB: Ajzen, 1991) was pitted against a similar model that was extended with a path from past to later BCU and ACU, respectively. The results suggest that bringing up the issue of condom use was equally predicted by intentions and past BCU. However, among people with casual partners, using condoms - and more importantly not using condoms - was especially predicted by past ACU, suggesting a strong habitual component. These results are discussed in terms of their implications for safe sex education and the use of theories in safe sex promotion campaigns.     

School-based,randomised controlled trial of an evidence-based condom promotion leaflet

A condom use promotion leaflet was designed for use with older teenagers in schools. The text targeted a series of cognitive and behavioural antecedents of condom use identified in the literature. Given previous evidence that motivational incentives can enhance the effectiveness of health promotion leaflets, the leaflet was presented in conjunction with a quiz and prize draw. Students were randomly assigned to either the intervention condition or a (no leaflet or incentive) control condition. Measures were taken immediately, pre-intervention and 4 weeks later from 404 students. The 20-min intervention successfully promoted six of the eight measured cognitions, namely (1) attitude towards using condoms with a new partner (2) attitude towards using condoms with a steady partner (3) normative beliefs in relation to preparatory actions (4) self-efficacy in relation to both preparatory actions and (5) condom use (6) intention to use condoms, as well as three measured preparatory actions, that is, purchasing condoms, carrying condoms and discussing condom use. The intervention did not increase condom use with steady or new partners but power to test intervention impact on condom use was curtailed.     

Predicting uptake of a routine cervical smear test: A comparison of the health belief model and the theory of planned behaviour

Abstract

This paper reports on a study carried out to identify predictors of uptake of cervical screening among 142 women (59% response rate) in inner London. Two social cognition models were used: The Health Belief Model (HBM; Becker, 1974) and the Theory of Planned Behaviour (TPB; Ajzen, 1991) and in addition anticipated affect following non-attendance for screening was assessed. The TPB emerged as by far the superior model for predicting screening intentions, explaining 51% of the variance in comparison with only 4% explained by the HBM variables. However, neither model was able to predict a significant amount of variance in uptake of screening three months later. Possible reasons for the poor prediction of this type of behaviour are discussed.     

Development and test of an integrative model of job search behaviour

Research on job search and the theory of planned behaviour (TPB) has identified job search attitude, subjective norm, and job search self-efficacy as the most proximal determinants of job seekers’ search intentions and subsequently job search behaviours. However, we do not yet know how more distal individual differences (e.g., personality) and situational factors (e.g., social context) might help to predict these key TPB determinants of job search behaviour. In an integrative model of job search behaviour, we propose specific relationships between these distal variables and the TPB determinants, which in turn are expected to mediate the effects of individual differences and situational factors on job search behaviour. The hypothesized model is tested in a large representative sample of 1,177 unemployed Flemish job seekers using a two-wave design and provides a satisfactory fit to the data. Extraversion, conscientiousness, core self-evaluations, employment commitment, financial need, and social support are found to differentially relate to instrumental job search attitude, affective job search attitude, subjective norm, and job search self-efficacy. In addition, all distal variables are indirectly related to job search behaviour through their effects on the TPB variables. These results support our expanded and integrative model of job search behaviour.     

A longitudinal application of three health behaviour models in the context of skin protection behaviour in individuals with occupational skin disease

Occupational skin disease (OSD) is common, associated with poor prognosis and poses a significant burden to the individual and society. We applied the theory of planned behaviour (TPB), the prototype-willingness model (PWM) and the health action process approach (HAPA) to the prediction and explanation of occupationally relevant skin protection behaviour in individuals with OSD. We used a longitudinal design. In this study, 150 individuals participating in a 3-week inpatient tertiary prevention programme completed measures assessing the constructs of the TPB, PWM and HAPA at admission (T?0), discharge (T?1) and once the individual had returned to work and worked for 4 consecutive weeks (T?2) (n?=?117). Intention was measured at T?0 and skin protection behaviour at T?2. Path analysis was used to assess the longitudinal associations of the models’ constructs with intention and skin protection behaviour. TPB as well as PWM variables accounted for 30% of variance in behaviour, HAPA variables for 33%. While not all predictions were confirmed by the data, all three models are able to inform us about the formation of skin protection intention and behaviour in individuals with OSD. The findings are discussed in light of future interventions and research.     

Perceived sexual self-control and condom use with primary and casual sex partners: age and relationship agreement differences in a Portuguese sample

Abstract

Objective: Consistent condom use is still not ideal. Research showed that perceived sexual self-control is associated with greater likelihood of using condoms. However, this association seems to vary according to age and relationship agreement (i.e. non-consensual non-monogamy, NCNM vs. consensual non-monogamy, CNM).

Design: Cross-sectional study with 307 heterosexual users of a dating web site for romantically involved individuals (81.8% men; M_age = 42.24, SD?=?9.65, range: 23–76 years). All individuals were in a romantic relationship (M_length = 13.47 years, SD?=?9.39).

Measures: Demographic information, perceived sexual self-control, condom use frequency (casual sex partners; primary partner in the last 3 months) and relationship agreement.

Results: Independently of relationship agreement, perceived sexual self-control was positively associated with condom use frequency with casual sex partners among younger and middle age participants, but not older ones (>49 years). Regarding the primary partner, a similar pattern emerged for CNM participants. In contrast, no significant association between perceived sexual self-control and condom use frequency with the primary partner emerged for NCNM individuals, regardless of age.

Conclusion: Our findings can inform evidence-based strategies to promote consistent condom use as an effective behaviour to prevent sexually transmitted infections, especially among older and NCNM individuals.     

Social-cognitive predictors of intention to vaccinate against the human papillomavirus in college-age women

This study examined social-cognitive predictors of college-age women's intentions to obtain the human papillomavirus (HPV) vaccine using the Health Belief Model (HBM) and Theory of Planned Behavior (TBP) as theoretical guides. Questionnaire data were collected from 143 women at a Midwestern university. Among the HBM variables, perceived susceptibility to HPV, perceived benefits of the vaccine, and self-efficacy to obtain the vaccine were significant predictors. Among the TPB variables, positive attitudes toward the vaccine and beliefs that important others would support vaccination predicted intentions. A model with all HBM and TPB variables explained nearly 60% of the variance in intentions. Comparison of the theories suggests that the TPB is a better predictor of intentions than the HBM. Results suggest that targeting personal beliefs about the vaccine, and increasing acceptance for the vaccine among social network members, may increase vaccination intentions among college-age women.     

Condom Use by Low-Income African American and Hispanic Youth With a Weil-Known Partner: Integrating the Health Belief Model,Theory of Reasoned Action,and the Construct Accessibility Model1

This study used multiple group structural equation modeling (SEM) to evaluate gender and ethnic differences in a theoretical model of condom use with a well known partner. The sample consisted of urban, low income, African American and Hispanic males and females. The theoretical model incorporated concepts from the Health Belief Model (HBM), Theory of Reasoned Action (TRA), and Construct Accessibility Model (CAM). A new theoretical concept, condom predisposition, emerged from SEM as a predictor of condom use in all four gender-ethnic groups. This concept combines elements of the TRA (attitude, partner norm) and CAM (accessibility of condom related constructs). Statistically reliable differences were found in the theoretical models for each group. For example, talking about AIDS was positively related to a predisposition to use condoms for African American males and both Hispanic males and females. In contrast, for African American females, it was their concern about AIDS that was positively related to this predisposition. These results underscore the importance of investigating gender differences within ethnic groups, and benefits of integrating different theoretical perspectives.     

Having Casual Sex: Additive and Interactive Effects of Alcohol and Condom Availability on the Determinants of Intentions

The impact of alcohol, condom availability, and gender on intentions to engage in casual sex and its antecedents was investigated. Students ( N = 384) who were or were not intoxicated with alcohol completed measures based on the theory of planned behavior (TPB) in relation to having casual sex in a scenario. The scenario described sex between 2 individuals not in a relationship and manipulated the consumption of alcohol of the sexual partners and availability of condoms. The data were supportive of the TPB: Intentions were predictable from attitudes, subjective norms, and perceived behavioral control (PBC). Results also support the inclusion of measures of past behavior and anticipated affective reactions, but not self-identity or moral norms as predictors of intentions. Alcohol in the scenario and condom availability increased intentions to have sex. There were also several interaction effects. Implications for using the TPB to understand sexual behaviors under the influence of alcohol are discussed.     

Condom use in steady and casual sexual relationships: Planning, preparation and willingness to take risks among adolescents

Condom use within steady and casual sexual relationships was examined among 14-16 year old Dutch adolescents from secondary school (N?=?140). It was hypothesised that among adolescents sex and subsequently condom use with casual sex partners is less likely to be considered in advance, more context-dependent and less habitual; whereas the opposite is true for steady relationships. Therefore, preparatory behaviours (buying and carrying condoms and communicating about condom use) were expected to mediate the intention-behaviour relation in the context of steady relationships, but not in the context of casual sex. Results confirmed that condom use with steady sex partners was explained by preparatory behaviours, habits, and to some extent, behavioural willingness, and that preparatory behaviours mediated the intention-behaviour relationship. Condom use with casual sex partners was predicted by risk willingness and intentions, without any mediation by preparatory behaviours. The results indicate that it is essential to increase awareness among adolescents that unexpected sexual situations may occur and to train them to take preparatory actions.     

Theory of planned behaviour and parasuicide: An exploratory study

Recent evidence suggests that parasuicide (deliberate self-harm) should be considered in terms of ‘normal’ rather than ‘abnormal’ behaviour. This study aimed to address this assertion by applying a social cognition model, for the first time, to parasuicidal behaviour. An extended theory of planned behaviour (TPB) model was tested on 55 individuals drawn from hospital and non-hospital populations. Thirty-eight percent of the sample (n=21) reported a history of deliberate self-harm. Findings supported the utility of the TPB: attitudes, subjective norm, self-efficacy, moral norm and anticipated affect discriminated significantly between those with and without a history of parasuicide. The extended TPB explained more than 50% of the variance associated with intentions to deliberately self-harm. These findings have considerable theoretical and practical implications for intervention. Future research should investigate the utility of the TPB employed within a prospective framework.     

What messages can foster safer sex among young women? Experimental evidence concerning the role of emotions and moral norms

Through a 2 × 2 × 2 quasi experimental design (N = 254), this research investigated if a social campaign eliciting positive emotions and activating moral norms might enhance condom negotiation skills, intended and estimated condom among young women with or without past sexual experience with casual partners. Emotions had a main effect on one of the six condom negotiation strategies we considered; for most of the other variables an interaction effect with moral norms and/or past behaviour emerged. Concerning estimated condom use, positive emotions worked better than negative ones when moral norms were salient. With respect to negotiations skills, positive rather than negative emotions seemed more effective for women with past causal sexual experience. In women without this kind of experience, positive emotions seemed to work better when moral norms were salient. Moral norms had a main effect on negotiation self-efficacy, but not in the predicted direction: when moral norms were more salient women were found to be less confident about their negotiation ability. These results suggest that a message which makes moral norms salient should at the same time elicit positive emotions in order to be effective; moreover, messages should be carefully tailored according to women’s past behaviour.     

Theory of planned behaviour and parasuicide: An exploratory study

Recent evidence suggests that parasuicide (deliberate self-harm) should be considered in terms of ‘normal’ rather than ‘abnormal’ behaviour. This study aimed to address this assertion by applying a social cognition model, for the first time, to parasuicidal behaviour. An extended theory of planned behaviour (TPB) model was tested on 55 individuals drawn from hospital and non-hospital populations. Thirty-eight percent of the sample (n=21) reported a history of deliberate self-harm. Findings supported the utility of the TPB: attitudes, subjective norm, self-efficacy, moral norm and anticipated affect discriminated significantly between those with and without a history of parasuicide. The extended TPB explained more than 50% of the variance associated with intentions to deliberately self-harm. These findings have considerable theoretical and practical implications for intervention. Future research should investigate the utility of the TPB employed within a prospective framework.     

Using the Theory of Planned Behavior to Predict Intention to Use Condoms Among Male and Female Injecting Drug Users

This study tested the utility of the theory of planned behavior (TPB) for understanding and predicting condom use intentions among male and female injecting drug users (IDUs). Interviews were conducted with 405 male and 315 female sexually active IDUs. Participants indicated their intentions to use condoms with main and nonmain sexual partners as well as attitudes, social norms, partner norms, and perceived behavioral control relevant to condom use with each partner type. The TPB accounted for 36 to 48% of the variance in intentions to use condoms. Intentions were related to attitudes, regardless of partner type. Partner norms were related to intentions to use condoms with main partners (men and women) and nonmain partners (men only). Social norms did not predict intentions, regardless of partner type. Perceived behavioral control was related to intentions to use condoms with main partners (men and women) and nonmain partners (women only). The findings are interpreted in light of the roles of cooperation, intimacy, and concern about self-protection.     

The 90's: gender differences in AIDS-related sexual concerns and behaviors,condom use and subjective condom experiences

To evaluate gender differences in the subjective experience and use of condoms, 193 heterosexual patrons at 13 bars in New York City were interviewed on site in 1991. Most respondents were single, middle class, and White; their ages ranged from 18 to 51 years. The data analysis was restricted to the 155 men and women who had at least 1 new partner in the 3 years preceding the survey. Respondents worried most about acquired immunodeficiency syndrome (AIDS) when engaging in sex with a new partner. 86% indicated concern about AIDS had affected their sexual behavior, most often by increasing their condom use and decreasing casual sex. 91% of women and 79% of men said that condoms give them greater peace of mind. Women worried more than men about AIDS when they had a new sexual partner and were more likely to limit their number of partners, work harder on an existing sexual relationship, give up casual sex, or give up sex with new partners. Men's subjective condom experiences were related to their penile functioning (erection and ejaculation) and the threat of loss of sexual pleasure. Multiple regression equations revealed that, among men, condom use with new partners was associated with worrying about AIDS and younger age; among women, peace of mind was a positive predictor. With casual partners, more partners led to increased condom use among women and worrying about AIDS was a predictor for men; peace of mind was predictive for both genders. 53% of men compared to 21% of women expected to meet a new sexual partner at the bar where they were interviewed, and 36% of men and 19% of women were carrying condoms with them.     

Predictors of Condom Use in Mexican Migrant Laborers

The purpose of this study was to explore predictors of condom use with occasional sex partners and regular sex partners, as well as carrying condoms in a new high-risk group for HIV infection, Mexican migrant laborers. This study extends previous findings by (1) exploring additional predictors not previously examined, (2) utilizing a large sample of male and female Mexican migrant laborers, (3) carefully controlling for the effects of various demographic and lifestyle variables related to condom use, and (4) assessing the interactive effects of gender on predictors of condom use. Snowball sampling was used to survey 501 adult Mexican migrant laborers. Results revealed that condom use with occasional sex partners was predicted by carrying condoms and condom self-efficacy and that women were more likely to use condoms with occasional partners when both men and women knew someone with HIV/AIDS. Condom use with regular sex partners was predicted by procondom social norms, less negative attitudes toward condoms, not knowing someone with HIV/AIDS, and condom self-efficacy. Carrying condoms was predicted by procondom social norms, less negative attitudes toward condoms, condom self-efficacy, worry about contracting HIV/AIDS, and women were more likely than men to carry condoms when both men and women were married. Understanding these findings, future research directions, and implications for condom promotion strategies with Mexican migrant laborers are discussed.